Non-surgical treatment options
Most people with a slipped disk are offered “conservative” treatment, meaning that the treatment does not involve surgery. This mainly involves exercise, relaxation and positioning, painkillers or local anesthetics, and manual and physical therapy.
Some slipped disks don't cause any symptoms, whereas others lead to severe back pain. A slipped disk in the lumbar region of the spine (the lower back) can press on the sciatic nerve and cause pain that often radiates down one leg and into the foot. Most people recover from a slipped disk within six weeks without treatment. Until then there are a number of treatment options that aim to help relieve the pain and improve mobility.
Exercise, relaxation and positioning
It used to be common practice for people who had a slipped disk to be advised to stay in bed for one or two weeks. Nowadays, the advice given is quite different. Keeping active is often strongly recommended because remaining in a lying position for a long time can make muscles and bones weaker, which can end up causing other problems.
Research has shown that staying active instead of getting bed rest is better for your mobility. However, whether people keep up with exercise or rest instead wasn't found to influence the back pain itself. So it is a good idea to try to carry out your normal daily activities as much as the pain allows. It has also been proven that exercise can effectively prevent back pain from returning.
Relaxation exercises may also be worth a try to help relieve back pain. How you perceive pain and how well you cope with it can be influenced by your mind.
If the pain is very severe, though, there is sometimes simply no other way to deal with it than to lie down and find a position that puts as little strain on your back as possible. Many people find the "psoas" position comfortable: While lying on your back, you put your lower legs on a raised platform high enough so that your knees are bent at a 90-degree angle. But it is important not to stay inactive for too long.
Medication for the pain
There are a number of different medications for the relief of sciatica caused by a slipped disk. Most of these are painkillers, but you can also take muscle relaxants and anti-inflammatory drugs. The following medications are the most commonly used. They are all available without a prescription when taken at a low dose:
- Non-steroidal anti-inflammatory drugs (NSAIDs): These painkillers belong to the same group of drugs as acetylsalicylic acid (ASA, the drug in medicines like “Aspirin”). NSAIDs that may be an option for the treatment of sciatica include diclofenac, ibuprofen and naproxen. They have a pain-relieving and anti-inflammatory effect. Because NSAIDs prevent blood from clotting to an extent, they can cause bleeding. The bleeding may be mild, such as a nosebleed or bleeding gums, but more serious bleeding can sometimes also occur, for example in the stomach or bowels. In some cases NSAIDs cause stomach ulcers, too. NSAIDs may also impair the function of the kidneys. If you have asthma, a cardiovascular disease, or a stomach ulcer, you should ask your doctor for advice before taking NSAIDs. NSAIDs can also be injected into muscle tissue, but that is generally not done anymore nowadays. NSAID injections probably don't have any advantages over tablets or suppositories, but it may cause nerve damage, bleeding or inflammation at the site of injection.
- Acetaminophen (paracetamol): Acetaminophen (paracetamol) is also a painkiller, but it is not an NSAID. It is well tolerated and can be used as an alternative to NSAIDs – especially for people who do not tolerate NSAID painkillers because of things like stomach problems or asthma. But higher doses of acetaminophen can cause liver and kidney damage. The package insert advises adults not to take more than 4 grams (4000 mg) per day. This is the amount in, for example, 8 tablets containing 500 milligrams each. It is not only important to take the right dose, but also to wait long enough between doses.
Prescription drug options include:
- Opioids: Strong painkillers that may only be used under medical supervision. Opioids are available in many different strengths, and some are available in the form of a patch. Morphine, for example, is a very strong drug, while tramadol is a weaker opioid. These drugs may have a number of different side effects, some of which are serious. They range from nausea, vomiting and constipation to dizziness, breathing problems and blood pressure fluctuation. Taking these drugs for a longer time can lead to habitual use and physical dependence.
- Steroids: Anti-inflammatory drugs that can be used to treat various diseases systemically. That means that they are taken as tablets or injected. The drug spreads throughout the entire body to soothe inflammation and relieve pain. Steroids may increase the risk of gastric ulcers, osteoporosis, infections, skin problems, glaucoma and glucose metabolism disorders.
- Muscle relaxants: Sedatives which also relax the muscles. Like other psychotropic medications, they can cause fatigue and drowsiness, and affect your ability to drive. Muscle relaxants can also affect liver functions and cause gastro-intestinal complications. Drugs from the benzodiazepine group, such as tetrazepam, can lead to dependency if they are taken for longer than two weeks.
- Anticonvulsants: These medications are typically used to treat epilepsy, but some are approved for treating nerve pain (neuralgia). Their side effects include drowsiness and fatigue. This can affect your ability to drive.
- Antidepressants: These drugs are usually used for treating depression. Some of them are also approved for the treatment of pain. Possible side effects include nausea, dry mouth, low blood pressure, irregular heartbeat and fatigue.
Anticonvulsants and antidepressants are typically not used unless the symptoms last for a longer period of time or the painkillers do not provide enough relief.
Manual and physical therapy
Manual and physical therapy are also used to treat sciatica following a slipped disk. Manual treatment may include massages and special techniques for relaxing tense muscles or locked joints. Physical therapy uses warming and cooling methods to relieve pain. These treatments are also called passive therapies, because patients do not have to actively participate. Common treatments include:
- Massages: Various massage techniques are used to relax muscles and ease tension.
- Heating and cooling: This includes the use of hot packs and plasters, a hot bath, going to the sauna or using an infrared lamp. Heat can also help relax tense muscles. Cold packs, like cold wraps or gel packs, are also used to help with irritated nerves.
- Ultrasound therapy: Here the lower back is treated with sound waves. The small vibrations that are produced generate heat to relax body tissue.
There is no overall proof that passive treatments speed up recovery or relieve pain especially well. Yet many people do find that heat application or massages are pleasant and relaxing.
Traditional Asian medicine
Treatment methods based on traditional Asian medicine include:
- Acupuncture: In acupuncture the therapist inserts fine needles into certain points on the body with the aim of relieving pain.
- Reiki: Reiki is a Japanese treatment which aims to relieve pain by using specific hand placements.
- Moxibustion: This method is used heat specific parts of the body (called "therapy points") by using glowing sticks made of mugwort ("Moxa") or heated needles that are put close to the therapy points.
There are very few good-quality studies on these treatments. Acupuncture is the only approach for which there is weak evidence that it might relieve pain – although this relief has been shown to be unrelated to where the needles are placed on the body.
Injections near the spine
Injection therapy uses mostly local anesthetics and/or anti-inflammatory medications like corticosteroids (for example cortisone).These drugs are injected into the area immediately surrounding the affected nerve root. There are different ways of doing this:
- In lumbar spinal nerve analgesia (LSPA), the medication is injected directly at the point where the nerve root exits the spinal canal. This has a numbing effect on the nerve root.
- In lumbar epidural analgesia, the medication is injected into what is known as the epidural space (“epidural injection”). The epidural space surrounds the spinal cord and the spinal fluid in the spinal canal. This is also where the nerve roots are located. During this treatment the spine is monitored using computer tomography or X-rays to make sure that the injection is placed at exactly the right spot.
Injections close to the spine can have side effects including bleeding, infection and nerve damage. A treatment involving many injections over a longer period of time may also lead to muscle weakness and is associated with radiation exposure. For this reason only a certain number of injections may be given within a particular time period. It is important to carefully weigh the pros and cons of having multiple injections.
Studies of these injection treatments have shown that they are able to relieve sciatica for several weeks. The people who were treated in the studies were able to go about their daily activities more freely.
Treating pain and staying active
Acute low back pain usually has no clear cause and goes away on its own after a few days. And even if a slipped disk is the root cause, your body will probably be able to deal with the problem on its own within six weeks. Most treatments will have a very small effect on the speed of recovery. Hot packs or massages might help you feel better. If you have severe pain, relaxing by getting into a position that reduces the strain on your back and taking anti-inflammatory drugs or local anesthetics can help relieve symptoms over the short term. But most of the work is usually done by the body itself.
If slipped disk symptoms persist for a longer time, surgery may be an option to try to relieve the pressure on the affected nerve. However, most experts believe that more operations for slipped disk are done in Germany than are actually necessary. So it might make sense to get a second opinion if your doctor advises you to have surgery and you are unsure whether this is the right treatment.
It is important to stay as physically active as possible despite the pain. Exercise will not only keep your body in shape, it generally also has a positive effect on your mood. It is important to get enough exercise to stop back pain from becoming chronic. Physical activity has been scientifically proven to have a preventive effect – and it is probably the most important thing you can do to help yourself.
Bhatia A, Flamer D, Shah PS, Cohen SP. Transforaminal Epidural Steroid Injections for Treating Lumbosacral Radicular Pain from Herniated Intervertebral Discs: A Systematic Review and Meta-Analysis. Anesth Analg 2016; 122(3): 857-870.
Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie Nicht-spezifischer Kreuzschmerz – Langfassung, 2. edition, Version 1. 2017.
Jordan J, Konstantinou K, O’Dowd J. Herniated lumbar disc. Clin Evid 2011.
Lewis R, Williams N, Matar HE, Din N, Fitzsimmons D, Philips C et al. The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model. Health Technol Assess 2011; 15(39): 1-578.
Li X, Han Y, Cui J, Yuan P, Di Z, Li L. Efficacy of Warm Needle Moxibustion on Lumbar Disc Herniation: A Meta-Analysis. J Evid Based Complementary Altern Med 2016; 21(4): 311-319.
Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ 2012; 344: e497.
Qin Z, Liu X, Wu J, Zhai Y, Liu Z. Effectiveness of Acupuncture for Treating Sciatica: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med 2015; 2015: 425108.
Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev 2016; (10). CD012382.
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.